Medium risk patients: Oral penicillin challenge

SAPG has updated its penicillin allergy de-labelling pathway to support removal of inaccurate penicillin allergy labels and improve access to appropriate antibiotic treatment. 

This page contains resources for patients assessed as medium risk using the using the penicillin allergy de-labelling (PADL) algorithm. 

More information on how to set up and run a PADL service can be found in the protocol for implementing penicillin allergy de-labelling in adult patients in acute hospitals. There is also a guide containing frequently asked questions for clinicians completing PADL.  

Additional resources available for de-labelling medium risk patients:  

• PADL algorithm.
• Penicillin allergy information sheet.
• Oral penicillin challenge information leaflet.
• Pre-test patient consent form for oral challenge.
• Managing patients experiencing allergic symptoms during the test.
• Patient post-challenge information: No penicillin allergy.
• Patient post-challenge information: Penicillin allergy confirmed.
• Penicillin allergy card (only for patients with penicillin allergy confirmed).
• Standard letters to GPs to communicate challenge results and actions required (no penicillin allergy or confirmed penicillin allergy).

For more information on penicillin allergy de-labelling, refer to the pages below:

• Penicillin allergy de-labelling.
• Patients identified as low risk on the PADL algorithm.
• Patients identified as high risk on the PADL algorithm.
• Full list of PADL resources.  

These are available to adapt for local use in Scotland. Outside Scotland, Attribution-NonCommercial (CC BY-NC) applies.   

Scottish Antimicrobial Prescribing Group (SAPG) | August 2026 for review Aug 2029

Content update October 2026